Jobs in the United States

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Added just now
Financial Reporting Analyst IV
University of Utah
Salt Lake City, UT
…Financial Reporting & Accounting and the Financial Reporting Manager, the position assists in preparing annual financial reports for component units, and the University’s consolidated…
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VP – Software Delivery
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Salt Lake City, UT
Maximus is currently seeking a VP of Software Delivery who is responsible for the end-to-end technical integrity of software systems delivered under a large, critical programs. This role…
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Technical Manager - Healthcare Claims Systems
Cognizant
Salt Lake City, UT
- $71,000 to $112,500 USD / year
We are seeking a Technical Manager with deep healthcare claims expertise to lead vendor management and release delivery for a large-scale claims platform environment. In this role, you will…
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Human Services Lead Licensor, DHHS
State of Utah - Jobs
SALT LAKE CITY, UT
…documentation review to ensure adherence to regulations and effective program implementation. If you have a passion for regulatory compliance and want to make a real difference in public…
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Fleet Zone Manager, San Francisco Market Area
Ford Motor Company
Salt Lake City, UT
Fleet Parts & Service Zone Manager is Ford Pro/Ford Customer Service Division corporate representative to large commercial and government fleet customers for all things Ford parts and…
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Senior Communications & Policy Project Manager
St. George Tanaq Corporation
Salt Lake City, UT
Tanaq Management Services (TMS) delivers professional, scientific, and technical services and information technology (IT) solutions to federal agencies in health, agriculture, technology,…
Added 5 mins ago
Sr. Material Planning Analyst
Rivian
Normal, IL
…This position is based onsite in Normal, IL and reports to the Manager of Material…
Added 6 mins ago
Service Production Supervisor
Rivian
Franklin, TN
Identify and nurture talent, creating clear development paths and providing hands-on training to elevate the team's technical capabilities.
Added 6 mins ago
Applications Engineering, Sr Engineer - FPGA
Synopsys
Sunnyvale, CA
…pressure, their past tool frustrations, and you shape your technical approach around what will actually move them forward. You do not pitch features, you solve problems. You have debugged…
Added 12 mins ago
Human Resources Business Partner
Amrize
Ada, OK
The incumbent must have ability to build relationships and get up to speed quickly on needs of the business and offer solutions
Added 12 mins ago
Depot Operations Manager
Leidos
Lawton, OK
The Logistics & Sustainment Department is seeking a Depot Operations Manager to establish, lead, and continuously improve depot maintenance and sustainment operations supporting advanced…
Added 12 mins ago
Project Management
Northrop Grumman
Oklahoma City, OK
Must have Bachelor's degree with 2 years’ experience, Masters Degree or in-lieu of degree with 6 years of experience
Added 13 mins ago
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Data Center Project Coordinator
TEKsystems
Boardman, OR
- $30 to $35 USD / hour
…role in Boardman, Oregon. MUST work on-site.DescriptionThe Program Administrator supports Data Center Operations leadership by providing program coordination, reporting support, project…
Added 22 mins ago
Senior Information Systems Security Engineer - Security Control Assessor (SCA)
Peraton
Quantico, VA
…to support an established federal enterprise cybersecurity program. The team will provide security engineering, control assessments, audit readiness, and governance, risk, and compliance…
Added 22 mins ago
Senior Information Systems Security Engineer - Security Control Assessor (SCA)
Peraton
Washington, DC
…to support an established federal enterprise cybersecurity program. The team will provide security engineering, control assessments, audit readiness, and governance, risk, and compliance…
Added 24 mins ago
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Project Controls Manager
Actalent
Hillsboro, OR
- $60.1 to $86.54 USD / hour
Job Title: Project Controls ManagerJob DescriptionThis Project Controls Manager role supports large-scale capital projects for a major client in the life sciences sector within a leading…
Added 25 mins ago
Sr. Digital Product Manager, Forecasting
Amgen
Washington D.C., DC
…managerial experience may run concurrently with the required technical experience referenced…
Added 25 mins ago
Regulatory Affairs Manager - CMC
Amgen
Washington D.C., DC
Experience preparing and compiling regulatory dossiers in accordance with ICH guidelines and Common Technical Document (CTD) structure.
Added 25 mins ago
Senior Water & Wastewater Project Engineer
Consor Engineers
Riverside, CA
Location: Candidates must reside in California and hold an active California PE license
Added 25 mins ago
Senior Water & Wastewater Project Engineer
Consor Engineers
Santa Clara, CA
Location: Candidates must reside in California and hold an active California PE license
Added 25 mins ago
Senior Water & Wastewater Project Engineer
Consor Engineers
San Francisco, CA
Location: Candidates must reside in California and hold an active California PE license
Added 25 mins ago
Senior Water & Wastewater Project Engineer
Consor Engineers
Oakland, CA
Location: Candidates must reside in California and hold an active California PE license
Added 25 mins ago
Senior Water & Wastewater Project Engineer
Consor Engineers
Walnut Creek, CA
Location: Candidates must reside in California and hold an active California PE license
Added 25 mins ago
Senior Water & Wastewater Project Engineer
Consor Engineers
Rancho Cordova, CA
Location: Candidates must reside in California and hold an active California PE license
Added 25 mins ago
Senior Water & Wastewater Project Engineer
Consor Engineers
Boise, ID
As a Senior Project Engineer, you will apply your technical expertise to the planning, design, and delivery of water and wastewater infrastructure projects. In this role, you will take…

WPS Health Solutions

Utilization Management RN

Denver, CO, United States

$40,123 USD / year

Apply on jobs.connectingcolorado.gov About employer

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Job details

Pay: $40,123 USD / year
Posting language: English
Posted: Nov 3, 2026

Original job description

Description Our Utilization Management RN (Registered Nurse) evaluates efficiency, appropriateness, and medical necessity for medical services, and procedures for our Health Plan. This role uses clinical knowledge to provide judgment to review medical services with evidence-based criteria, authorize requested services as appropriate. Our Utilization Management RN will be responsible for referring questionable cases to medical directors to prevent unnecessary procedures, treatments, or prolonged hospital stays. We're looking for someone who's open to cross-training in Case Management (CM), with the potential for the role to grow into a combined UM/CM position or transition into CM in the future. Start Date: 01/10/2027Salary Range: $75,000 ~ $100,000The base pay offered for this position may vary within the posted range based on your job-related knowledge, skills, and experience. Work Location We are open to remote work in the following approved states:Colorado, Florida, Georgia, Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Nebraska, New Jersey, North Carolina, Ohio, South Carolina, Texas, Virginia, Wisconsin How do I know this opportunity is right for me? If you:

Enjoy working with healthcare professionals to facilitate appropriate and quality services in a cost-effective manner to positively impact medical loss ratio.
Can work closely with Medical Directors to facilitate decision-making process for the Health Services department.
Have experience reviewing medical and behavioral health prior authorization requests for medical necessity and appropriateness of requested treatment according to medical policies and evidence-based criteria.
Have experience working closely with members of Health Services, and key contacts in Sales, Member Services, Claims, Provider Contracting, and Billing & Enrollment.
Can document case summaries and refer cases to Medical Director that do not meet internal or external guidelines, policies, or medical criteria.
Like to be accountable to monitor and maintain inventory in the Utilization Management queue to meet productivity standards.
Enjoy evaluating, analyzing, and reporting trends in utilization changes in all healthcare delivery areas.
Can make recommendations and implement changes consistent with Health Services objectives of quality care and reasonable cost.
Would enjoy identifying opportunities and provide recommendations to improve department processes.
Have Identified legal or liability issues and refer potential ethical or risk management issues to the appropriate department for resolution.
Have participated in training new nursing staff on department workflows, policies, and procedures.
Can work cross functionally to support other departmental efforts to ensure overall efficiency, quality, productivity, and compliance with all departmental, regulatory and URAC standards.

Minimum Qualifications

Registered Nurse (RN) with current licensure in the state of Wisconsin.
4 or more years of experience as a Registered Nurse in varied clinical settings (i.e., hospital, clinic, home care, skilled nursing facility, etc.).
2 or more years of experience in Managed Care (i.e., prior authorization, utilization review), preferably within a commercial health plan.
Demonstrated experience managing and coordinating care effectively for case managed members.
Strong knowledge of current medical practices, medical coding, trends and patterns of care.
Familiarity with health plan operations, payer/provider relationships, and insurance benefits.
Strong diverse experience and expertise that includes:
The ability to work independently, manage a case load, and prioritization.
Excellent analytical, critical thinking, problem-solving skills and decision-making skills.
Excellent communication and interpersonal skills to work with members, providers, and teams
Proficiency in Microsoft Office and healthcare software and systems.

Preferred Qualifications

Bachelor's degree in nursing (BSN).
Certified Case Manager (CCM) and prior experience in Case Management (CM) within a health plan.
Background in commercial health insurance, including Point of Service (POS) or Preferred Provider Organization (PPO) plans.
Knowledge of Utilization Review Accreditation Commission (URAC).
Certified Managed Care Nurse (CMCN).
Technical experience with word processing, spreadsheets, and proficiency with electronic medical record (EMR) systems and/or other managed care software.

Remote Work Requirements

High speed cable or fiber internet
Minimum of 10 Mbps downstream and at least 1 Mbps upstream internet connection (can be checked at https://speedtest.net)
Please review Remote Worker FAQs for additional information

Benefits

Remote and hybrid work options available
Performance bonus and/or merit increase opportunities
401(k) with a 100% match for the first 3% of your salary and a 50% match for the next 2% of your salary (100% vested immediately)
Competitive paid time off
Health insurance, dental insurance, and telehealth services start DAY 1
Professional and Leadership Development Programs
Review additional benefits: (https://www.wpshealthsolutions.com/careers/)

Who We Are WPS, a health solutions company, is a leading not-for-profit health insurer and federal government contractor headquartered in Madison, Wisconsin. WPS offers health insurance plans for individuals, families, seniors and group health plans for small to large businesses. We process claims and provide customer support for beneficiaries of the Medicare program and manage benefits for millions of active-duty and retired military personnel across the U.S. and abroad. WPS has been making healthcare easier for the people we serve for nearly 80 years. Proud to be military and veteran ready. Culture Drives Our Success WPS' culture is where the great work and innovations of our people are seen, fueled and rewarded. We accomplish this by creating an open and empowering employee experience. We recognize the benefits of employee engagement as an investment in our workforce-both current and future-to effectively seek, leverage, and include differing and unique perspectives that fuel agility and innovation on high-performing teams. This results in people bringing their authentic selves to work every day in an organization that successfully adapts to business changes and new opportunities. We are proud of the recognition we have received from local and national organization regarding our culture and workplace: WPS Newsroom - Awards and Recognition. Sign up for Job Alerts FOLLOW US! Instagram LinkedIn

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Equal Opportunity Employer/Protected Veterans/Individuals with DisabilitiesThis employer is required to notify all applicants of their rights pursuant to federal employment laws.For further information, please review the Know Your Rights notice from the Department of Labor.

Wisconsin Physicians Service Insurance Corporation is an Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities employer. Apply at: https://ipc.us/t/23B9A6487560425E.

Apply on jobs.connectingcolorado.gov About employer

More about this job

Skills

RN
Case management
Decision making
Sales
Manage inventory
Reporting
Risk management
Regulatory compliance
Medical coding
Work independently
Prioritization
Critical thinking
Problem solving
Communication skills
Interpersonal skills
Microsoft Office
EMR

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Work requirements

Jobs in the United States